The Clinical Review Specialist assesses the medical necessity and appropriateness of healthcare services to ensure alignment with established guidelines
Job Summary
The Clinical Review Specialist assesses the medical necessity and appropriateness of healthcare services to ensure alignment with established guidelines.
This role involves reviewing electronic medical records to evaluate documentation accuracy while participating in department quality improvement initiatives.
Employees receive competitive base pay, comprehensive benefits, and opportunities for career advancement within a not-for-profit organization.
Matching Summary
The Clinical Review Specialist assesses the medical necessity and appropriateness of healthcare services to ensure alignment with established guidelines.
Salary
Base: $63,648.00 - $90,750.40/Annual; Bonus/Equity: Not specified; Benefits: Comprehensive benefits, career advancement, differentials, premiums, and bonuses included
Skills & Requirements
Must-have
Review medical records for guidelines alignment
Assess documentation accuracy and completeness
Participate in quality improvement initiatives
Provide clinician education on standards
Nice-to-have
Strong analytical skills for patient data
Experience creating educational materials
Collaborative team environment focus
Key Requirements
Bachelor's Degree in Nursing or related field
3+ years CDI specialist training or risk adjustment experience